Provider Demographics
NPI:1407881832
Name:BOWLING, BRUCE T (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:T
Last Name:BOWLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 HOOPER RD
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-3698
Mailing Address - Country:US
Mailing Address - Phone:607-754-3863
Mailing Address - Fax:607-754-5697
Practice Address - Street 1:415 HOOPER RD
Practice Address - Street 2:ENDWELL FAMILY PHYSICIANS LLP
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-3698
Practice Address - Country:US
Practice Address - Phone:607-754-3863
Practice Address - Fax:607-754-5697
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00557539Medicaid
88510OtherMVP SELECT
4210349OtherAETNA
58140OtherGHI HMO
878446OtherAETNA HMO
NY0042948OtherCHAMPUS
10031769OtherCDPHP
1040OtherEMPIRE BS
1040OtherBLUE POINT
1040OtherEXCELLUS
1040OtherHMO BLUE
9689459OtherGHI
88510OtherMVP SELECT
B82129Medicare UPIN